Stade 2008 Secondary Disabilities and Fetal Alcohol Spectrum Disorder Dr. Brenda Stade, PhD, APN St. Michael’s Hospital, Toronto

Stade 2008 www.faseout.ca

Secondary Disabilities and Fetal Alcohol Spectrum Disorder

Dr. Brenda Stade, PhD, APN St. Michael’s Hospital, Toronto.


Introduction: Secondary Disabilities

• Often secondary disabilities emerge in adolescence and adulthood

• Secondary disabilities are believed to result from complications of undiagnosed or untreated primary disabilities


Introduction:Secondary Disabilities

• Mental health problems

• Disrupted school experiences

• Easily victimized

• Trouble with the law

• Confinement


Introduction:Secondary Disabilities (cont.)

• Inappropriate sexual behaviour

• Alcohol and drug problems

• Needing dependent living situations

• Problems with employment


Secondary vs. Primary Disabilities

• Are they the same or are

they different?


Executive functions ofthe prefrontal cortex

working memory

planning time

perception internal

ordering

self-monitoring

regulation of emotion

motivation

inhibition



• Impulsive and uninhibited

• Passive and withdrawn one minute, switching to volatile temper tantrums the next

• Unpredictable; may need 24 hour supervision

• Depression, Extreme Anxiety



• Hyperactive in non-goal directed activity

• Unable to stay focused on task: to follow rules, finish household chores, school assignments or keep commitments

• Genuine innocence and detached attitude



• Impulsive – sexually inappropriate, stealing

• “Short-sighted”

• May expect immediate gratification

• Engaging and charismatic yet creative at re-framing reality.


Impact of FASD


Experience of Living with FASD

10-year-old stated:

“Learning is hard. The teachers don’t explain things (in a manner that allows her to understand).”



18-year-old stated:

“They (teachers, employers) expected me to do things I couldn’t. I have a hard time doing some things. Others (kids his age) do things easier, get through work ….”



21-year-old stated:

“It (FAS) really does effect quality of life. It affects, school working, friendships…. How does it affect me? Differently. I do things differently…..My brain is rewired differently (than others).”



8-year-old stated:

“(It’s) hard, hard to keep out of trouble, and I am not that smart. Everybody makes fun of me.”


Hope for Positive Outcomes

21 year old stated:

“The disability happened, it’s a disadvantage. It is not a disability. I don’t like to use it as an excuse (for not participating in life)”.


Hope for Positive Outcomes

19 year old stated:

“I don’t have the best brain. … But it still works”.


Protective Factors

• Being raised in a nurturing stable environment

• Diagnosis before age 6

• Having a diagnosis of FAS rather than ARND

(Streissguth et al., 2004)


Interventions:Diagnosis


Why Diagnose?

• New understanding leads to new strategies at home and other environments

• Opens doors for services

• Better medical management.


Interventions:Psychosocial


Interventions: Psycho-social

• Mental Health Programs – behavioural, social skill development

• Counselling: family doctors, social workers, nurses, adolescent paediatricians, psychiatrists, psychologists

• Support Groups


Interventions: Psychosocial

• Activities that foster confidence and social development

• ? Medication


Interventions:Learning


Interventions: Facilitate Learning

• Psychological Assessment

• Modification of School/Job Training Programs:

– Small Size of 8 to 10– Individual Educational Plan– Resource Teacher – Job Coach


Six Strategies for Teaching Individuals with FASD

1. Structure and routine is critical

2. Less talk and more multi-sensory learning opportunities

3. Be concrete and don’t assume anything. Teach and re-teach


Six Strategies for Teaching Individuals with FASD

4. Facilitate language. Use specialists to help with language development.

5. Gross motor programming is important These students need to move.

6. Reduce stimulation, use visual cues.


Interventions: Facilitate Job Success

• Work environment that is accepting of areas of weakness not just areas of strength

• Structure

• Supervision

• Modified Work Hours


Interventions: Facilitate Independence

• Identify housing that matches the individuals needs

• Economic support and protection

• The “External Brain”

• A community that cares


Interventions:Strategies for Success


Strategies for Success

• Observe patterns of behaviours

• Identify strengths, skills and interests

• Reframe the interpretation of behaviours

• Provide structure rather than control

• Establish routines and consistency


Strategies For Success

• Build transitions into every routine

• Model behaviours

• Provide simple instructions or cues

• Identify behaviours which indicate the accumulation of frustrations

• Help develop skills for expressing feelings



• Provide specific support for social skill development

• Understand the various forms of communications

• Include as many sensory modalities as possible to facilitate integration of information and experience



• Consider information processing abilities

• Reevaluate expectations and goals for the individual: Clarify whose needs are being met by the goals

• Clarify goals and values for education/job training and independence



• Advocate - Anticipate - Co-ordinate – Accept

• Integration of culturally relevant values and traditions

• Environment


Thank you!

Documents

Stade 2008 Secondary Disabilities and Fetal Alcohol Spectrum Disorder Dr. Brenda Stade, PhD, APN St. Michael’s Hospital, Toronto